Do Beef, Eggs, and Chicken
Belong in Your Diet?
And Why Cholesterol Still Matters
Warning: The Following Information Could Save Your Life!
It’s pretty rare that I start an article with such an attention-grabbing statement. After all, the words “save your life” are overused.
We’ve recently seen viral videos on how a sharp hammer could save your life (if your car ends up in a river and you can’t open the window), or how “tsunami balls” could save thousands of lives.
It’s a fact that we tend to worry more about things that are very unlikely to harm us than what is most likely to kill us.
For example, you may be worried about violent crime, traffic accidents, terrorism or brain cancer. But in reality, your chances of dying from any of those things are relatively small.
On the other hand, we don’t worry too much about the things that are most likely to kill us.
And this killer is… heart disease.
- Still the leading cause of death in the United States. To put things in perspective, one in every four death is due to heart disease, or about 600,000 people in the USA every year.
- In Canada, heart disease is the second killer, right after cancer.
- In Europe, the statistics are even more shocking. More than half of deaths are due to heart disease.
Ok, so heart disease is a big deal. But why am I bringing this up?
Am I going to scare you off eating eggs, beef, chicken and dairy and again claim the disproven nonsense that high cholesterol causes heart disease?
That’s exactly what I’m going to do, but without the nonsense part. And the reason is…
- There’s too much misinformation at the moment on the Internet on this topic, and thousands of people are going to die as a result.
- This subject is dear to me.
On this last point, I lost my father when I was only 35 (he was 63) to heart disease.
My dad, just like most people, never took this terrible disease seriously, until it took his life.
His lifestyle was not the best, so many of my readers, I suspect, might be thinking, “This can’t happen to me because I lead such a healthy life.”
I don’t have the stats on the most common causes of death in the vegan, paleo, or “natural health” world, but from the anecdotal evidence I get, they are roughly the same as those of the population as a whole. Numerous famous vegans and health authors have died of heart disease — and if you don’t pay attention to this important topic and act upon it, there’s a good chance you’ll die of heart disease too.
Why? Because it’s SO common disease in Western societies.
And from my guess, you live in Western society, and therefore are exposed to the same risks as everyone else. You grew up on the same diet, and in spite of your best efforts to change your lifestyle, your risk of dying of heart disease is rather high — compared to the almost non-existent risked you would have faced if you had lived in a more traditional society.
You might be questioning my scare tactics that I’m using to start off this article, but my motivations are:
- I want you to pay attention
- Choosing to act on the wrong kind of information can lead to your early death
- I like you, and I’d prefer if you stayed alive to read my articles
Got it? So let’s begin!
Cholesterol and Heart Disease
Every time I write an article warning people against eating beef, eggs, and other high-cholesterol foods, I get angry and passionate readers write back with more or less the same information that they’ve read somewhere online and are spitting back.
Here are some replies I received on my last article about eggs.
“You are totally misinformed about “eggs.” There is no “scientific” research condemning cholesterol in eggs. Our brains need cholesterol to function & without it; we can’t regrow our brain cells. Eggs have many nutrients especially in yolks required by our bodies.”
“Eggs are an ideal food, but they need to be organic, truly free range, and not over cooked. There really just aren’t enough studies for you to say that eating eggs will raise cholesterol if you are already eating a healthy diet and practicing healthy living. The body, especially your brain, needs cholesterol, it is the precursor to many hormones, it is a needed nutrient.”
“We need Cholesterol! It is NOT a true indicator of Cardiovascular Dis-ease. The true indicator is homocysteine one of my friends has “Perfect” Cholesterol which the “Practicing Western medicine doctors” monitors giving Him FALSE hope of health when He has a heart attack.”
A common thread in those replies is the necessity of consuming cholesterol in food because “our brain needs cholesterol.” We’ll see how that’s false in a moment.
More importantly, these replies show who these people have been reading on the Internet. Mainly anti-vegetarian bloggers who have created a sort of conspiracy theory around cholesterol and heart disease.
The main statements made by these anti-vegetarian authors are:
- “High cholesterol is not the primary cause of heart disease.”
- Diets high in saturated fats and cholesterol don’t cause heart disease
- Saturated fats don’t raise cholesterol
- Eating animal foods doesn’t increase cholesterol levels or risk of heart disease.
Every one of those statements is false. Choosing to believe them is something you’ll do at your risk and in spite of all the evidence available.
Naturally, it’s important that we explain this information first. Otherwise, here’s what’s likely to happen:
- If you think that high cholesterol is not the primary cause of heart disease, you’ll probably dismiss blood tests that show high levels of cholesterol, and continue with your existing diet and lifestyle
- On the other hand, if you accept the premise that high LDL cholesterol is the primary cause of heart disease, you’ll likely take those blood results more seriously and act accordingly. At least, you’ll have been informed.
- If you believe that a diet high in saturated fats and cholesterol cannot be a cause of heart disease, you’ll likely give yourself a free license to eat lots of saturated fats and cholesterol
- On the other hand, if you accept the premise that diets high in saturated fats and cholesterol can be a major risk factor for heart disease, you’re more likely to act differently, eat different foods, and do the best you can to avoid beef, eggs, chicken and high-fat dairy.
What Is Heart Disease?
First, let’s define heart disease, so we don’t get lost in our search for the truth. From now on, I’ll often refer to heart disease as cardiovascular disease or CVD.
CVD is not one disease but a set of conditions involving the heart or blood vessels. Many diseases are included under this umbrella: angina, heart attack (myocardial infarction), strokes, and many others.
The primary pathology leading to heart disease is atherosclerosis. Preventing atherosclerosis is what you want!
Atherosclerosis is primarily a thickening of our arteries from an accumulation of white blood cells. We call this “fatty streaks.”
This stuff contains cholesterol, dead cells, white blood cells, and a bunch of other nasties.
We can understand atherosclerosis as an inflammatory and a scarring process.
A few crucial considerations:
- Atherosclerosis is completely asymptomatic. It can go on for decades without you noticing it or affecting your blood flow.
- The most common path to a heart attack is not necessarily the progressive narrowing of the arteries, but rather the sudden rupture of plaque, which leads to a sort of “clot” — rapidly slowing or stopping blood flow
- If you were born in a Western country and exposed to a “Western” diet, you most likely have a good degree of atherosclerosis — even if you’ve lived a good portion of your adult life on the healthiest diet possible.
- This led Dr. Greger to say (and I’m paraphrasing): The question is not “how are you going to prevent heart disease” but rather “what are you going to do about the heart disease you already have”?
The last point is important.
I have heart disease; you have heart disease. We all have heart disease.
Why? Because everyone exposed to the Western lifestyle develops atherosclerosis from the earliest age.
It’s not something that only happens to people who eat burgers every day or smoke two packs of cigarettes. It happens to everybody. It’s just a question of time before it kills us, and the only reason why it doesn’t kill everybody is that some people end up dying of other diseases before their heart disease kills them.
Therefore, our goal is not to prevent heart disease.
Our goal is to avoid the worsening of our existing heart disease so we may die of another cause of death (ideally a natural one at a proper age!). We may even reverse some of the atherosclerosis we already have.
The good news is that if we don’t worsen our existing heart disease, we’ll most likely be okay without ever feeling any symptoms of it.
The Proof That High Cholesterol Is the Main Factor in Heart Disease
CVD is a complicated disease that involves a lot of factors and includes an inflammatory process.
But the important thing to remember is that elevated LDL levels are the most important factor of all.
Without high LDL, it’s almost impossible to develop CVD even if one engages in lots of risky behaviors like smoking and being sedentary. As long as LDL levels are low (under 70-80 mg/dl)), atherosclerosis will not occur.
There are several pieces of evidence we can look at to support our statement that high LDL levels are the primary cause of CVD.
- Traditional societies where cholesterol levels are less than 150 mg/dl (total cholesterol) don’t experience any atherosclerosis and almost no CVD.
- On the other hand, as cholesterol levels increase in other societies, the prevalence of CVD increases.
- Total cholesterol is associated with CVD, but LDL cholesterol is the strongest positive correlation.
- Placebo-controlled, double-blind studies in humans have shown that individuals with CVD with lowered LDL experienced fewer fatal or symptomatic events, compared to control groups.
- Wild primates maintain low LDL cholesterol levels and don’t suffer from heart disease.
- It is possible to cause heart disease in herbivorous mammals by feeding them large quantities of saturated fats and cholesterol.
- It is NOT possible to induce atherosclerosis in carnivorous species by feeding them any amount of saturated fat or cholesterol.
- “In contrast to feeding cholesterol and/or saturated fat, it is not possible to produce atherosclerotic plaques in herbivores by raising the blood pressure chronically, by blowing cigarette smoke in their faces for their entire lifetimes, or by somehow raising the blood glucose levels without simultaneously feeding them an atherogenic diet.” William C. Roberts.3
Here’s from the summary by William C. Roberts, current editor of both the American Journal of Cardiology and the Baylor University Medical Center Proceedings.
“Among the many genetic and environmental risk factors that have been identified by epidemiological studies, elevated levels of serum cholesterol are probably unique in being sufficient to drive the development of atherosclerosis in humans and experimental animals, even in the absence of other known risk factors. In humans, the majority of serum cholesterol is carried by LDL particles.” 2
But… My Cholesterol Is Healthy!
One of the most common misconceptions I get about the link between cholesterol and heart disease is people thinking that their cholesterol is healthy when in fact it is simply in the “normal” zone.
A “no-worry” cholesterol is an LDL level below 70 mg/DL or total cholesterol below 150 mg/DL. If you can get your cholesterol that low while eating all the eggs you want, be my guest!
But all the people who have written to me that they eat plenty of eggs and have “healthy” cholesterol are still in the danger zone.
Here’s from a fascinating study co-authored by Loren Cordain, Ph.D. and author of the Paleo Diet!
Can Your Cholesterol Be Too Low?
Some people, when they follow a low-fat vegan diet or a raw vegan diet, come back with surprising blood test results, with cholesterol levels so low that their doctor is puzzled and even worried. They’ve just never seen any patient with levels that low.
With total cholesterol levels way below 150 mg/dl (for example 120 mg/dl), some people start believing that their cholesterol levels might be too low.
Many paleo authors claim that low cholesterol leads to depression and other health problems.
Hunter-gatherers, long-lived agricultural societies, most mammals, and even human infants have very low cholesterol levels.
Here’s again from the study I quoted earlier:
Let’s consider the following:
- Other mammals without heart disease have LDL less than 80 mg/dl.
- Hunter-gatherers have low cholesterol, with a total cholesterol of about 70 to 140 mg/dl (35-70 mg of LDL).
- Wild primates have total cholesterol levels below 120 mg/dl
- LDL level in newborn humans is around 30 mg/dl
- Infants have total cholesterol levels of 50-90 mg. 10
- What we need is in the range of 25-60 mg/dl for LDL, and total cholesterol of 110 to 150 mg. 6
- Official Recommendations (Mayo Clinic) for LDL Cholesterol: Below 70 mg for people at very high risk of heart disease.
How Much Cholesterol Do We Need?
Optimal for LDL seem to be 50 to 70 mg/dl. Lower is better and physiologically normal.
Your total cholesterol can be very low compared to Western standards, and yet this can only be a good thing unless the cause of your low cholesterol is not your healthy diet and lifestyle but rather a pathological condition that happens to cause a drop in cholesterol levels as well.
But, Isn’t Cholesterol Essential to Life?
One of the arguments of many Paleo bloggers and dissidents is that “cholesterol levels is essential to life,” therefore: “you don’t want it to be too low.”
Yes, cholesterol is essential to life. That’s why our body produces it… just like every mammal does, including herbivorous ones!
The problem is that our diet and lifestyle increases our cholesterol levels past a breaking point, where too much cholesterol becomes a problem.
If you lower cholesterol via natural methods, we can say that: the lower is better — because you’ll be relying on your body’s ability to produce the cholesterol it needs.
It’s also possible to suffer from a disease condition that also causes our cholesterol levels to be low not as a result of a healthy diet.
For example, malaria (parasites) lowers cholesterol. Some diseases cause cholesterol to be lower. So, that’s why people have lower cholesterol at the end of their lives.
Sometimes, this is why low cholesterol levels are associated with certain diseases. The low cholesterol is a consequence of the condition, not likely a cause!
“Cholesterol is an essential component of the cell membrane and an obligate precursor for bile acid, steroid hormone, and vitamin D synthesis. (…) Although individuals with serious chronic illnesses, such as cancer, often develop depressed LDL levels as a result of malnutrition, epidemiological studies show that people with naturally low LDL levels are associated with improved longevity.” 15
What Causes High Cholesterol
Hopefully, I’ve convinced you that elevated LDL cholesterol levels are the most important risk factor for CVD.
The question is naturally: what causes elevated LDL cholesterol levels?
Here, there’s confusion. We know that several factors can affect our cholesterol levels
- Our diet
- Exercise or lack of exercise
- Drinking unfiltered coffee
- Being overweight
Let’s focus specifically on nutrition to try to answer the following questions:
- Does dietary cholesterol raise LDL cholesterol level?
- Does fat intake, and particularly saturated fat, increase cholesterol levels?
- What is the most important dietary reason for high cholesterol is Western populations?
Does Dietary Cholesterol Increase Blood Cholesterol?
There is a lot of substantial controversy regarding dietary cholesterol — what is food in animal foods such as eggs, beef, chicken and fish. We know for sure that an elevated blood cholesterol causes heart disease, but what accounts for high cholesterol?
In the book “Cholesterol and Beyond,” which is one of the most compelling scientific book ever compiled on the research on heart disease — the conclusion is that dietary cholesterol may affect plasma cholesterol.
The evidence is not so clear because many studies contradict each other and come to different results.
Different animals react differently when fed dietary cholesterol. When rabbits are fed cholesterol, some of it is absorbed, and the rest is not excreted because rabbits cannot increase bile acids. Therefore their cholesterol goes through the roof.
Humans cannot absorb much dietary cholesterol, and when we ingest some cholesterol we produce less, so that’s why their blood cholesterol does not increase as much as that of rabbits.
Many studies done in the 1960s and 1970s on humans show that increases up to 600 mg. of cholesterol a day produce an increase in blood cholesterol. After that, the increase stops. Some people respond more than others, and in many individuals adding dietary cholesterol to the diet does not produce a rise in blood cholesterol.
One Key Finding
New research revealed that cholesterol has a greater effect if we add it to someone on a low-cholesterol diet.
If your cholesterol intake is zero, adding 500 mg/day (about two eggs) would raise your cholesterol by an average of 10 mg/dl.
But if your diet already contains 500 mg/day, then adding another 500 mg will only raise cholesterol levels by 1.50 mg/dl, according to the research.
Here’s another study showing what happens to the blood cholesterol of people on a low-cholesterol diet when we feed them a ton of eggs.
If you read my articles you probably have a pretty healthy diet, so the question is whether they include an egg or two or some meat would be harmful. If you start with zero cholesterol in your diet, this inclusion can cause a significant increase. 10 mg/dl may not sound like much, but it is quite remarkable considering this is just the “average” from the research (you may experience a much higher rise) and that each 10 point increase or decrease in LDL cholesterol significantly affects your risk of heart disease.
These findings also mean that for someone eating two eggs a day or one egg and some meat or fish, NOT eating those foods would mean a drop in cholesterol level JUST from the cholesterol content alone. But cholesterol is not everything…
The Link Between Saturated Fat and Heart Disease
So the link between dietary cholesterol and blood cholesterol is not overwhelming but can be significant if you are sensitive and you start with a low cholesterol intake or are considering removing all cholesterol from your diet.
One scientific point where there is much less debate is how saturated fat increases blood cholesterol.
The first studies on the topic showed a link between total fat intake and blood cholesterol. Then they noticed that it was the saturated fat content of the diet that raised blood cholesterol. Replacing saturated with unsaturated fat lowered cholesterol levels.
Here’s a summary of the research on the topic:
- A high fat intake is linked to high blood cholesterol
- Serum cholesterol goes up with butter intake, and down with sunflower seed oil. Olive oil raises cholesterol a bit due to its saturated fat content.
- Studies done on populations living on a low-cholesterol diet, such as the Javanese in the Dutch East Indies between 1916-1922, showed that a diet rich in saturated fat and cholesterol raised their cholesterol dramatically. In this example, from 128 to 168 mg/dl in just three months.
- Not all saturated fatty acids have the same effect. Myristic acid is the most potent cholesterol-elevator. Stearic acid has little or no effect on blood cholesterol. (Studies later showed that stearic acid could be converted to oleic acid in the body). The biggest sources of myristic acids? Palm oil, coconut oil, and butter fat.
- When researchers Brown and Goldstein discovers the receptors for LDL cholesterol in cells (which gave them the Nobel Prize in Medicine, 1985), we understood how saturated fats raise cholesterol levels. They suppress LDL-receptor activity, and less LDL-cholesterol is taken up by the cells. So they increase the “pool” of cholesterol by affecting how the receptors work. Unsaturated fats have the opposite effects.
Want More Proof?
I don’t know how much proof I’d need to give you to convince you that eating saturated fats raises cholesterol levels. You could start by reading “Cholesterol and Beyond” by A. Stewart Trusdell, a non-vegan book with no affiliation with any vegetarian associations (it does not even recommend a vegan diet specifically), which is a complete review of the research done on cholesterol between 1900 and 2000.
But if that’s not enough, you could find proof in the pudding. The paleo pudding…
Why do so many paleo followers complain of high cholesterol? Take a look at some of the articles on the topic you’ll find online:
One article by Mark Sisson, leading Paleo advocate, stood out for me in its idiocy and lunacy. Mark starts by agreeing that for many followers of the diet, LDL cholesterol skyrockets. He obviously understands that this is a problem. Otherwise, he wouldn’t dedicate an article on what to do about it.
But next, his suggestions are ridiculous. According to him, lack of exercise might be to blame. “Take a walk,” he says! He also suggests “lifting heavy things.” The level of denial is high.
How Paleo Bloggers Get the Research So Wrong
This article is getting pretty long, and I could not possibly review ALL of the studies that show no correlation between saturated fats and high cholesterol. But I will cover one to show you the flaws in these studies.
We start with a blogger that I enjoy reading and highly respect, Stephan Guyenet, who’s a biochemist and neurobiologist who writes about obesity and nutrition.
He may have changed his mind since, but in 2011 he wrote a comprehensive article questioning the link between saturated fats and blood cholesterol.
He starts off by quoting a 1963 study that showed no link between animal fat intake and blood cholesterol.
However, when I looked at the study, it told a different story.
The researchers said that “animal protein shows low positive correlations with cholesterol level.” That means they see some correlation. Next, they say that carbohydrates have the opposite effects.
They then recognize the flaws in their study.
And finally they talk about our beloved “threshold,” the same problem we ran into with dietary cholesterol. When someone is already on a high-fat diet, adding MORE fat to the diet does not change blood cholesterol much!
Finally, results matter. All the research shows that if you include almost no cholesterol in your diet, and eat whole plant foods with a minimal amount of saturated fats (no coconut oil), you’ll have the lowest LDL cholesterol possible, which will lower your risk of heart disease significantly.
If you eat lots of saturated fat and cholesterol, you will raise your blood cholesterol significantly, thereby increasing your risk of heart disease.
If someone can prove the opposite, then please show me the results! Most likely they will be exceptions rather than the rule.
And by “prove the opposite” I mean:
- An LDL cholesterol below 70 mg/dl
- Total cholesterol under 150 mg/dl
Recently, Gary Taubes, an author who loves saturated fat and cholesterol, posted his blood test results to prove to the world that his diet is healthy. This is from a man who starts the day with sausages.
Buried in the date, you’ll find the “numbers that kill.”
Gary Taube’s cholesterol levels are:
- 116 mg/dl of LDL
- 204 mg/dl of total cholesterol
That puts him in the high-risk category for heart disease, and we can safely say that atherosclerosis is building up in his arteries with every bite of sausage that he takes in the morning.
I rest my case.
In summary, what I said in this article is very simple, but nonetheless critical to understand:
- Blood cholesterol does matter, and in fact are the most important risk factor for heart disease. LDL cholesterol is the number to watch.
- Dietary cholesterol does increase blood cholesterol in many individuals
- Saturated fat and animal protein, in general, does raise blood cholesterol
- There are many things you can do to lower your risk of heart disease, but one of them is to keep your animal food consumption to a minimum (by that I mean to do the best you can to avoid it altogether).
Questions You’ll Probably Ask
What about HDL cholesterol?
Yes, I mostly focused on the “bad” cholesterol (LDL) because that’s the number that matters.
HDL is the high-density lipoprotein that may be protective for heart disease risk based on the research. Although HDL may be protective, the goal is still to lower your LDL to desirable levels, even though that may mean that your HDL goes down a bit too.
What About Particle Size?
One reader commented on a previous article I wrote on the topic:
The LDL particle size and number are the important things, not merely just LDL.
Some people say that large, fluffy LDL particles are not as bad as small and dense LDL particles. But even those large particles matter! Large LDL raise heart disease risk by 44% versus 63% for the small SDL particles.
No matter how you look at it, LDL cholesterol causes atherosclerosis. The debate around large vs. small sized LDL particles is like the debate some people have on the best way to commit suicide without pain.
The French Paradox
Another question from a reader:
Also, what about the French people in France, who eat more saturated fat and cholesterol but have less heart disease?
This one is so annoying but true. The French Paradox was not due to red wine or any other component in French people’s diet. It was due to statistical error and the fact that as much as 20% of heart disease deaths went under-reported in death certificates, put by local doctors as “other causes.” It turns out that French people die of heart disease as much as you’d expect, considering their diet high in animal fats.
Heart Disease is Caused by Sugar!
Up until 1984 scientists were working out the theory that sugar could cause heart disease. John Yudkin, professor of nutrition at London University in the 1960s, pointed out that with increased sugar consumption, heart disease also went up.
Yudkin tested his theory with animal experiments, feeding a high-sugar diet to rats. It increased triglycerides, but less consistently cholesterol. The dairy, egg and meat industries promoted Yudkin’s idea. His sugar theory was popularized in a number of books he published at the time. But these ideas were later discredited by the scientific community.
Here’s from Cholesterol and Beyond, referring to how the sugar hypothesis was rebutted:
By the 1980s these sets of evidence included:
- Sucrose does not ordinarily raise plasma cholesterol.
- It does not raise plasma triglycerides if energy balance is maintained.
- There is no plausible mechanism from animal experiments whereby sucrose could lead to CHD
- Experimentally induced atheroma in primates regresses on very low fat, high sucrose diets.
- Several countries with high sugar intakes had low rates of CHD, e.g., Cuba, Venezuela, Costa Rica.
- Sugar intake has not been found an independent risk factor in prospective studies.
- No prevention trial of CHD with sugar restriction has been completed, started, planned or even contemplated.
Please post your comments, questions, or send your hate mail below!
1 SOURCE: (Arteriosclerosis, Thrombosis and Vascular Biology. 1987:7:612-619 – “Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake”)
2, 3 SOURCE: (Cell, Vol. 104, 503-516, February 23, 2001 Christopher K. Glass and Joseph L. Witztum Specialized Center of Research on Molecular Medicine and Atherosclerosis Other source: book called “Nutritional and Metabolic Bases of Cardiovascular Disease”)
4 Source: (Familial hyperalaphalipoproteinamia J Lab Clin Med, 1976, Dc,88(6)-941-57)
5 Source: (The Johns Hopkins Textbook of Dyslipidemia) – Peter O. Kwiterovich, Jr., MD)
6, 7 Source: (“A Receptor-Mediated Pathway for Cholesterol Homeostasis” – Nobel Lecture, 9 December, 1985 by Michael S. Brown and Joseph L Goldstein)
8, 9 SOURCE: (“Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia” – Circulation, 2008; 118:672-677)
10 SOURCE: (Serum Cholesterol Concentration in New-Born African and European Infants and Their Mothers) – American Journal of Clinical Nutrition, Vl 4, No. 8, 1962)
11-16 SOURCE: (James H O’Keefe, MD*; Loren Cordain, PhD†; William H Harris, PhD*; Richard M Moe, MD, PhD*; Robert Vogel, MD‡ J Am Coll Cardiol. 2004;43(11):2142-2146. doi:10.1016/j.jacc.2004.03.046 http://content.onlinejacc.org/article.aspx?articleid=1135650)
17 SOURCE: (“Role of cholesterol in parasitic infections” – Lipids in health and disease 2005,4:10)